Hi, I'm Sarah Lavonne and I'm so glad you're here. Here at Bundle Birth, we believe that your life has the potential to make a deep, meaningful impact on the world around you. You, as a nurse, have the ability to add value to every person and patient you touch. We want to [music] inspire you with the resources, education, and stories to support you to live your absolute [music] best life both in and outside of work. But don't expect perfection over here. We're just here to have some conversations about anything birth, [music] work, and life. Trying to add some happy to your hour as we all grow together. [music] Bye nurses for nurses. This is Happy Hour with Bundle Birth Nurses. We are back for episode two talking about postpartum psychosis particularly related to the Lindsay Clancy case. And so if you have not heard episode number one, please pause right now. This will literally barely make sense to you because we are picking up exactly where we left off in the conversation. We're going to jump in literally right smack dab in the middle. And so pause right now, go back to to part one and then you can come back to this episode two. And so for those of you that have listened to episode 1, let's pick up the conversation where we left off. So then when we talk about treatment, um I know you're not a clinician, so we're not going to go like what's your treatment regimen, but what have you seen in your experience of working with others and in yourself that when you say it's highly treatable, what does that look like? So, well, I I will tell you what I think the ideal treatment probably is um is what was described a long time ago as having the woman be protected and cared for with um access to her child. So, she's not isolated and isn't afraid that her child is going to be taken away from her and that she's treated with kid gloves. She was treated gently and lovingly. M. So, probably the closest thing to that are the mother baby units in the UK. Okay. But we don't have them here. Yeah. [laughter] I'm like, "Oh, boy." The closest probably the closest thing that we have are the um specialized impatient uh facilities here in the United States. And I think I think we might be up to five of them now for all of the United States. Um and I think most of them have last I knew around 8 to 12 beds. When you look at how many women are likely to need and these are not specialized inatient units that are only postpartum psychosis. Okay. Right. they are for for severe paranatal mental health and that can be um a other type of thing besides psychosis because if you need impatient for it and you need um really professional knowledgeable care um I don't know what exactly what their qualifications are but I know it's not limited to psychosis so that's not enough beds and it is not close enough for a lot of families because it's not like we're like okay all of you people who are going to get psychosis go cluster around that place so you can have access to it. That's not realistic. And also a barrier to anybody actually receiving care because no one wants to actually leave their home. Well, exactly. There's that and and if you have other kids, you're going to go three states away for treatment. Yeah. Yeah. Right. And if you think about the cost of treatment, we don't even really start talking about the cost of missed work for both the for both parents because what happens when one is hospitalized, right? You're both out of work because one's caring for the kids most likely or caring for the kids and traveling or the cost of whatever hotel you might be staying in with the kids or any number of other expenses that come. I mean I know people who have gone bankrupt because of this illness for sure. Yeah. Yeah. So um so we do not we really don't have good facilities for this and it's heartbreaking because people say well what should I tell a family? Well the the going thing to tell a family is go to the ER. That is not that is by far not an ideal thing to do on many levels. One it can get missed. That's one of the you know up their levels. Um so I think if families I mean in an ideal world families would have somebody going into the process with them. she would have gone through um an assessment of her mental health prior to uh giving birth early in the pregnancy. Uh so you can notice other things because we also know that anxiety during pregnancy is a big problem, right? It can lead to poor fetal outcomes. So you know ideal world probably before pregnancy [laughter] we just had better mental health care in general for all of us all the time, right? And and that includes education of the people who who have it, right? Like, oh, you've not been able to sleep for a week at all. Well, this might not just be bad sleep habits. You might have something going on with you. It might be like a bipolar. So, I mean, because we can better identify risk for any of these uh mood disorders if we know more about her history, if we know more about what's going on with her, and if she feels confident in disclosing, the better educated, the more resources that the family has and that she has, the more they can rely on, she will be okay with proper care. and that it's important to get proper care because if you don't it can get worse. It's not that it's going to stay the same. It can get worse. So, and not to mention the risks. So, if they know they can do that and that proper care is available and that it's highly treatable, then there's all of those reasons for saying I cannot reveal this start to go away. And because and and and we start addressing a lot of the stigma as well, right? because we're not just educating the families who've had something go wrong. We're educating everybody. So, one of the things I have frequently started to say is I believe we need to center postpartum psychosis in our education, in our awareness. Not that it's the only thing, but if we were able to reduce barriers to care for it, if we were able to make sure those women were dealt with in a way that isn't traumatic, that doesn't scare the heck out of them if they reveal what's going on with them. Yep. If we were able to destigmatize that then a lot of the and if we and if we did close examinations to determine is it possible that she's experiencing that then the other things the OCD the PTSD generalized anxiety the depression are more likely to be also dstigmatized properly cared for properly educated about. Mhm. So and and then of course treated early and more and and early tends to have better outcomes for all of them. Yeah. Yeah. So if we sort of center psychosis and make sure that's taken care of, we also take care of the other ones. But when we treat psychosis as a rare outlier, something not to be concerned about, it has the opposite effect on all of them. Because a woman might not seek help when she's depressed because she's afraid the baby's going to get taken away cuz she doesn't know that there's treatment available. If you know there's treatment available even for someone with psychosis, then it makes it a lot easier to reveal even if what you have is depression. Mhm. So what I'm hearing like I'm picturing the world you're painting, right? And I'm thinking about that like, oh, all of a sudden we actually see patients within that two week window, which by the way is starting to happen some places. It's definitely not widespread widespread, but some practices that is sort of happening. but also that practitioners have the education they need to recognize and ask the right questions while also destigmatizing mental health in general while also actually looking for and starting from a postpartum psychosis and working your way down without the stigma around it's your fault, it's like oh you or that like you've had that thought, right? Those like judgments that we have that like, you know, or like, "Oh, well, of course they do cuz you were anxious during pregnancy or whatever." I mean, you talk about stigma this entire time we've been talking. I'm like, "Oh my god, we got to work on that." So, they destigmatize around mental health. They center postpartum psychosis. they get seen at two weeks that in the like prenatal period there's some education going out specifically to the family of looking for and the big one I'm hearing is like something off right that like they're not themselves. It doesn't have to be these like grandiose changes, but like that's weird. Or like, hm, that's unlike you. And instead of disregarding them and going like, "Oh, they're just postpartum and not the postpartum that they've been using in this trial of saying like postpartum when they really mean depression, OCD, anxiety, whatever, that they are postpartum and they are generalizing that that then that would be able to be to bring to the attention of either the postpartum person and or the practitioner who receives that information, takes it serious, and goes, I'm going to treat this as if it were a disease, right? like a cancer instead of a ooh the drama, right? And evaluate appropriately. And then it sounds like if it is ruled in for psychosis that the treatment is inatient, ideally in a specialized unit, at least specialized related to postpartum, maybe one of these dream units of the five in the states or more, however many exist, and that they would go impatient, that they would still have access to their baby, that they would be supported in sharing their thoughts. It likely means medication from my understanding. Um and then and then as far as timing goes like how long are they thinking in patient and then also the services that's the other piece of like and then that there would be social services to support these families that don't stigmatize and that support them realizing that this is fully outside of the person's control and that these families need support in this season that won't last forever if they actually get the support that does exist somewhere but none of us really know where because our mental health services are lacking in general. Is that am I on to am I on to it? I think that that would definitely be a big improvement. [laughter] I start [gasps] I mean there's a there's also a catch 22 to this, right? So one is I do think robust awareness, dstigmatization and education is is crucial because that allows a much better exchange between any professional and the woman, right? If you have that trust. On the other hand, yes, we need to train professionals because as we've seen, the myths, the misinformation, and the stigma are still robust within the medical and mental health community. Not intentionally, but they are there. And so, right now, I think a lot of women are getting and families are getting the message of if you seek help, you still won't get it. People say, "Oh, if something's wrong, seek help. you'll be okay. But we don't [clears throat] really have a system that you can promise that. What it is is yeah, here's what you need to do to have a chance at the best outcome. We can't guarantee, but as professionals in the field, and this is important, too, for for labor and delivery and for parent educators, knowing what the resources in your area are and knowing what resources those in your area might be able to accept to access. So, for example, if I'm in Connecticut and I know that there's a a specialized inpatient unit in North Carolina and that my client here could go there and is going to get much better care there, knowing that and knowing how to access that, knowing what it takes for that client to go there, even though not every one of my clients here would be able to, being familiar with the resources, having them know what kind of resources, knowing that I'm pretty store Mass General um they have had a provider line where providers can call to get specialized information on how to deal with the client that they have that has psychosis and that is not limited by type of profession. Yeah. So that is a huge resource for somebody who thinks they have somebody who might have psychosis but and I don't know but they postpartum support international mass general both are likely to have some uh information on who are the professionals in your area that might be qualified to do this other than just like a Google search. Also, a lot of states have postpartum support international chapters that may have that information. So, being proactive and having that in your back pocket before something happens and even having the information on different organizations, different resources. There's an organization called Action on Postpartum Psychosis in the UK. They have the most robust information particularly for families, for partners, for those expecting. They've got practical advice. They they have the best materials right now that I know of that are out there. They are for the UK. So, there's a lot of terminology and there's a lot of specifics. So, they say when the home visitor comes, well, okay, well, that doesn't apply, right? So, but they have a lot of other good information in them. So, I would always use them as a resource for general information for families if they want to learn more, knowing that it's a UK resource. Those things can be included on the packages that they get sent home as a reminder, not as the education, but as the reminder, as the go-to handy sheet. And I think this as as a nurse myself, I'm like, well, I think one of the action steps that I see for myself andor all of us is that we would take it upon ourselves to do the research andor ask around and or look at the resources that are being given to patients for the local resources available. I know in California, Southern California, there's Maternal Mental Health Now. They're incredible. Um, and I've done a bunch of their conferences and they're very much local. They have like you put in your zip code and it comes up with a perinatal therapist, psychologist, psychiatrist that specializes in the perinatal period um, in your area. And so I think for all of us that's one of those things that I think we we are taught to like well leave it up to social work or I'll call for a social work consult and they know the resources versus like no this is our specialty and I'm a part of this community and I am going to own my practice in this way knowing that I'm a part of the solution as well no matter where I have my touch points which we're moving into the labor and delivery thing and then we got we'll wrap it up but um that like I would I would own the fact that I'm going to have some references I'm going to know what resources are available in my area and where I could push people towards as needed. That's a good point. There are a lot of other organizations that have resources available, but that's another thing is if you are in this field, not just knowing what those resources are, but connecting with them. So yeah, so there's a lot of other types of resources and again with regard to psychosis, it's good to know those, but also all of the other potential maternal mental health issues that can occur. Totally. Totally. It's good to have those resources. So we're speaking mostly to labor and delivery nurses here. And I know that the labor and delivery nurse in me, part of what I have loved about being a labor and delivery nurse is that you deliver them and then you say bye. [laughter] And I get to say like somebody else is going to handle the postpartum recovery. Somebody else is going to handle the breastfeeding education. As much as I love talking about breastfeeding, but I like the quick turnaround of being a labor and delivery nurse. And so I think it's easy to hear this and go, "Yeah, this is my areaish, but this particular postpartum issue doesn't really apply to me." What would you say to that? Well, it's funny that you asked because I mean, you've probably seen online a lot of people who are like, "Well, Lindsay Clancy was a labor and delivery nurse, so of course she knew about this." And I was like, I don't know. Nope. That is not an assumption to make at all. Case in point right here. Exactly. It's like I mean, it would be great if they all did. I think it'd be great if the general public knew, but yeah, I also know enough to know there's a good chance that they don't have specialized training in it. Um, and certainly not up to-date specialized training. Yes. Amen. So, we don't even I can't even say that I would think that most people who are psychiatrists have that specialized training. Yeah. I mean, it's like I mean, clearly we saw that with one of the guys on on the stand the other day. I was like, "Oh my god, sir." I wouldn't I wouldn't expect that of any profession. Um, but labor and delivery. Yeah. In particular, why would you need to know? One reason is because you're part of the general public and you happen to interact with a lot of pregnant and postpartum women, even if it's just briefly before they're no longer pregnant or briefly after postpartum. Yeah. And because most of the labor and delivery nurses that I've met are both very attuned to detail and very empathetic but without being unprofessional about it, right? I mean, um, they care about what's going on. She's laughing because I was like, Mhm. Yeah, that's right. We we are attention to detail. That's that's what I teach them. Like my our whole job is assessment, y'all. like we have to be expert assessors and so we're going to see it. We better see it. [laughter] Anyway, continue. So, even though there's likely not going to be enough information, reliable, determinable information for making a diagnosis that occurs in that period, that doesn't mean there won't be things that have her go, hm. Now, I say that knowing that if I look at my own experience that with both pregnancies, I think there was something that would make somebody go, hm. Um, and with my first, it's it would be less likely that it would have been caught than with my second. And with my second pregnancy, I didn't have psychosis, but um I went into labor um in the afternoon, late into the night. They ended up stopping labor. We I then labor started again in the morning. Went in delivered early in the morning. Was at the hospital overnight. Did not sleep at all. Overnight. So I can imagine there being a labor and delivery nurse is like, "You didn't sleep at all." Yeah. Right. and be like, "Oh, lack of sleep and still having plenty of energy, which is what I was exhibiting, could be a red flag." Now, I was okay. But in that moment, a you know, if you still aren't sleeping in a couple days, really, you should contact this person, right? Also, I have twins. One of them kept forgetting to know how to breathe. So she ended up after not breathing with me and then after being taken into the nursery and having another episode of not breathing, they took her to the NICU. So that NICU does not mean anything about psychosis, but all NICU moms and dads should be given resources to help them with the mental health challenges that can come with all of the different feelings that come when you have a child that goes to NICU. Yep. We need to do better to help NICU moms. [laughter] Yeah. And that would be the providing resources not specific to psychosis. again if you send her psychosis you know we'll deal with the other ones but having resources for that with my oldest with my first the one I had psychosis with again I had an oops during pregnancy and I looking back I think um I went into shock and I think there was some concern that that was because of the loss of blood and things like that but I think if you've had a traumatic birth Again, red flag that this mom might need some extra support. Yeah, definitely. Even if it isn't psychosis. So, one of the things that labor and delivery nurses can do that can help those who end up getting psychosis is giving them robust materials and emphasizing if you have somebody who delivers that has had any kind of risk, someone you know is um a survivor of sexual assault, someone that you know has a potentially dangerous situation at home, somebody that you know has a history of mood disorders, somebody whose child is going to NICU, someone who had a traumatic delivery, somebody who's delivered a child who the child has challenging health issues, right? All of those are parents that beyond the usual this person might need help, which is also real. Yeah. And it's good to provide them with resources. Gives you an opportunity to reinforce. Hey, in this packet you see here, I've got my little highlighter. I'm going to circle here are some resources that you might need. Oh, and by the way, here's some information on checking in with yourself and some questions you might want to go over. And do you remember that pre-birth education on page 20? Just some reminders, you know, in case you want to refresh on that. Just like some things to give them as touch points and reminders because a bunch of papers in a to- go packet. [laughter] Yeah. Gets thrown to the side otherwise. Yeah, that's you cannot cannot count on those are the things that moms look at. So even if you say, "Oh, they're in the discharge packet." Taking the moment to pull that out, circle it with a highlighter. If you struggle, here are the local resources you might want to contact. Yep. Love it. Because again, especially if she has the education and the family has the education that they can notice things going wrong, the next step is having at their fingertips. How do you get help? If you notice something, you don't have to diagnose. And here's how you can do that first step of getting help. Do you have any commentary on the Lindsay Clancy trial from your vantage point? Yeah. So, well, when I saw it in the news, and she's not the only one. Uh, there are other cases, but when I saw it in the news, I thought, "Oh, that looks like a postpartum psychosis." And when I say postpartum psychosis, what I'm talking about is a sudden and severe psychosis related to pregnancy. Postpartum psychosis, some people are saying, "Oh, it's only when you have an onset within some brief period of time." And to some extent, that's true, especially for research. But when we're talking about having a sudden psychosis that's related to the conditions of your body from being pregnant and birth, [clears throat] um there's a longer period of time where that can be relevant, right? Sure. Uh so medication intervention that causes trips you over into psychosis is one of them. So with um postpartum psychosis, what I'm referring to is um I'm using that term because that's generally used. I tend to use the term paranatal psychosis, okay, for that and postpartum for the shorter just because I think we need to start doing that because it's going to be in the DSM eventually with the shorter time period. People are mistaken to think it's that shorter time period. What did the professional say? Something like four weeks, which boy is that old research. No, that's that's like been debunked, too. That's what's so frustrating being having knowledge while I'm hearing them testify. I'm like, "Somebody correct him." [laughter] He's wrong. Let me say what do you what did you base that on? Yes. Oh, well there's this research study back in 1920 or whatever. Yes, sir. Nothing recent. So then um there was nothing that I've seen that has had me go, oh maybe that's not postpartum. Everything I'm seeing is consistent with what I would expect something like that to look like. Mhm. And if I had any doubt, I saw um I think it was the counts or paragraphs or whatever um 79 and 80 or thereabouts of the civil case where Lindsay describes her state of mind uh during the most tragic part of her story. Um and I hadn't read that before or seen that before. I'd only heard very generalities and when I read that it was like oof that is so much like my experience and I can absolutely read that and be like one if you're trying to persuade people that you were psychotic you wouldn't write it that way because it doesn't sound like what people expect. M and second of all, it's very much like my own experience when I had psychosis. I was just fortunate, lucky that that didn't happen with me. And I really 100% believe that the only thing that separates me from women whose stories end with tragedy is luck. I was lucky. You mentioned the civil case. I haven't read the civil case, but I know that there's civil. So, for those of you that aren't aware, there's the criminal case and then there's the civil case. The civil case, from my understanding, is suing the medical professionals that they would alleged over first of all didn't care for her well enough and then maybe overmedicated is my understanding. Is that also your understanding? Yeah. I mean, I think misdiagnosis is probably part of it, too. I haven't read the whole thing, but Yeah. Yeah. Yeah. And I've been following the criminal case versus the criminal case says like who's responsible for the deaths of the children. And so you mentioned the civil case and how it sounds like postpartum psychosis and or you were able to relate to it. And so I've pulled it up. And so once again, I know we've talked a lot just about being mindful, but also we're grown here. And I know for me, I hear that and I'm like, well, I got I got to go read it. And so I have it up here and I'm going to read you the account from January 24th, 2023. And keep in mind also this is the civil case. And so my understanding of civil is that the details that they placed in this can also be changed after the criminal case based on the outcome of the criminal case. like it's not quite as concrete or you're not quite as stuck as you are in the criminal case, which is why some would allege that this is not a confession. This is intentionally a part of the civil case. So anyway, again, I know that like we probably have a verdict at this point, but at this current recording moment, we do not have a verdict yet. Okay. I want us to think through the lens of postpartum psychosis. This could be something that is how postpartum psychosis sounds. On January 24th, 2023, Lindsay woke severely depressed with suicidal thoughts. She gave the children breakfast. She took Cora to the pediatrician because Ka complained of stomach ache. Later, she went to the backyard with the children, built a snowman, and sent a picture to Patrick and her mother. The suicidal hallucinations continued all day non-stop. Later in the afternoon, the voice began saying, "You should harm the children." Lindsay thought about dinner and realized she had not prepared anything. She asked Patrick about takeout. She took she looked at a map to see how long it would take because she did not want to be alone and needed help. As soon as Patrick left to pick up the food, there was a loud demanding repetitious voice. This is your last chance. Kill the children so you can kill yourself. In all caps, this is your last chance. You have to kill the kids so you can kill yourself. Lindsay felt a force come over her. Lindsay experienced command auditory hallucinations, a quotes demanding powerful male voice explicitly ordered her. She felt an overwhelming irresistible compulsion to comply, entering a dissociative dreamlike state where her physical actions felt utterly dis disconnected from her conscious valition. She perceived her body was just acting and she was merely watching herself do it. She reported she had no choice but to follow these compelling directions. Lindsay described, "I lost all control. My body started acting without any control on my part. I was just following commands. All action. This voice demanded action." Lindsay proceeded to strangle each of her children, utterly uttering, "Oo, this is dark, so FYI, this is dark." Lindsay proceeded to strangle each of her I'm going to cry. This is really, really hard to hear. She proceeded to strangle each of her children, uttering, "Go to God, baby." Following these acts, she undertook a severe suicide attempt, ingesting a substantial quantity of various medications, self-inflicting lacerations on her wrist and neck, and jumping from a second floor window approximately 20 ft to the ground below. She suffered catastrophic injuries, including thoracic spinal cord injury, resulting in permanent paralysis below the sternum. She also offered suffered multiple closed fractures of her cervical and thoracic vertebrae and multiple rib fractures. Kora and Dawson died on January 24th. Kalen Kalen succumbed to his industry injuries and died on January 27th, 2023. Lindsay consistently maintains her actions were compelled by a hallucinatory voice, not a conscious decision, and expresses profound enduring love for her children. Yeah, the command hallucination is [sighs] that comes up in a number of the tragedies. I'm very fortunate. I did not have that as part of it, but the whole sort of absence of self, absence of choice, watching yourself. I mean, I read that and it was like a gut punch because I was like, it's so hard, I think, for somebody who hasn't experienced that to understand like we are never not in our own minds that way. Will you share your hallucination with us? So, I was having lots of different symptoms of psychosis, but I wasn't revealing them. I was just saying that I needed help. Um, I had this delusion. I was having intrusive thoughts about harming my child and then I had this delusion where it made sense to me. And yet I didn't seek help in part because I know I wouldn't do something like that. But I was in my my own sort of way of seeking help was telling those around me, I can't cope. I can't do this. I'm not I'm I'm a terrible mom. And just being reassured, you're doing fine. You're doing great. You're a good mom. Obviously, you love your child. you're doing a great job taking care of her, etc. Um, instead of like, why would you say that, right? What's going on with you? And then the worst part of my experience was I was in my room with my child. And if trigger warning, this is a little graphic, so listeners who are sensitive to this, again, go in another room for a few minutes. Um, and I saw myself take a sewing shears and cut my daughter open from pubis to neck. And um, there are details to that I'm not going to share, but it was sure very graphic. And so as if it existed or you knew it was a delusion. No, no, no. I was I was like watching myself do this like I thought it was happening. Okay, but I was watching myself. And when I say watching myself, not like in a dream where you're up on the ceiling maybe and see your whole body, but seeing my hand with the scissors doing this, knowing it was me doing it, but being and I can't really explain this, being absent of thought. I wasn't horrified that I was doing it. There was no malice. There was no anger. There was no intent. There was no It was like I was blank and just watching this happen. Not being controlled by somebody else, but not having control either. Not dream like, but like it was happening. But then I looked away and I was telling myself, "Okay, it's just one of those one of those bad thoughts. It's just one of those bad thoughts." Yeah. And I went and found anything I could find in the room. Looked around the room for anything that was sharp so that I wouldn't be able to harm her. As if you would need to find something sharp to harm an infant. and all the time keeping my head averted from her so that I wouldn't see her because I also knew that I had killed her. Like both things in my mind at the same time. Mhm. I took the few things I found over into another room and I put them on the in the very back of a closet on the top shelf, telling myself that if I had the impulse to harm her that I would have to go to that room, get all the way up on the top shelf again to get something and that in that amount of time I would be able to come to and not do whatever I was thinking, which of course makes no sense. But in my mind at the time it made perfect sense. Sure. Sure. And then also during that time I was going through a legal analysis. I was thinking I need to get help but what if I get help and there's no help available. Like what maybe this is a one-off that's never happened before. And if that happened and I did and I revealed what I was, you know, this thought and what had happened and if I revealed that and then I did harm my child, then I would get the electric chair. So I couldn't seek help. And I knew already that I couldn't reveal to my husband details because in my paranoia, I thought that it has been his plan all along to get me locked up in an insane asylum so he could have full custody of our daughter. Like all this stuff was already It's like it was there was a lot of components to this delusion. Yes. Yeah. Yeah. Well, the the paranoia was already existing that was, you know, its own separate but still present thing. In my right mind, I would never have said, "Oh, if I seek help and be and am detailed in what I reveal and I can't get help and I harmed my child, then then I could be punished because I would always in my right mind prioritize my child's safety. Even though I was doing this legal analysis of what would happen, I was also not in my right mind." Yeah. So you could say I didn't, you know, you could this whole planning thing and this and that and it's just not clearcut. People want to apply these very logical rational parameters to what a woman does. But the problem is that's not the way the illness operates. Y So if you took what I did and were like, well, you made a choice not to report. Well, I made a choice based on my delusional thinking. Mhm. And not based on who I am as a person and the choices that I would normally make. Sure. If I had harmed my child, I have no doubt there would have been plenty of fodder for people to believe I was just an e evil mom who didn't love my child. Yeah. And and by the way, later before I knew more and did research for my book, I was like, "Oh my gosh, that was messed up thinking that help seeeking would be used to show that it was premeditated." Mhm. And then I found out that a lot of women who are in prison for this type of scenario sought help and that helpseeking was used to show that which is one of the things that I really appreciate about the people who are showing support for Lindsay because saying she sought help relieves a lot of the blame on her versus she sought help therefore she must have planned it. There are still people who say that, but I'm just going to be liberal with the use of terms. They're delusional. [laughter] They don't understand the illness. They're just saying things that have no no actual reality to them. So, with my own experience, after that happened, I walked back into the room where my daughter was. And in that moment, I saw her on the bed cut open. M it is it still gets me. It is the single worst experience of my life cuz I believed that I had killed her. That experience

pales in comparison to those who actually have harmed their children. I just have a little tiny window [snorts] of empathy for them because I know how horrid that was. I cannot imagine [snorts] how deep that horror would have been had that been real. Yeah. I was alone. I have no idea how long I was in this state of seeing that and believing what I was seeing was real. It was almost like it was all people talk about a a switch being flipped. It it seemed more like I was seeing one thing and then there was a brief like smallest amount of darkness and then what I was seeing was different and then what I saw was her just sleeping peacefully on the bed. In my right mind, I would have gotten help right away. I would have called my husband been like, "You have to be here." I would have left the house to be not be near her. Yeah. But I wasn't in my right mind. I didn't have whatever I needed to be able to seek help. I do believe had I known her what I know now or what is available to most people to know now, what we can educate families to look for, what we can educate women to look for. I fully believe if I knew that then, even before that happened, I would have been able to seek effective help. my husband would have been able to seek effective help or at least seek help. Hopefully, it would have been [laughter] effective but at least seek help um have the chance of getting that kind of help and more and more I think there is more effective help available now. Um but I didn't I didn't know and I didn't seek help. Fortunately, after that, I I actually don't know because time is so fuzzy at that point in time. And I went from that into a really deep depression. And I'm not sure I really couldn't even tell you right now if I'm sure whether or not I had any hallucinations after that. But I didn't have any more thoughts of harm. Yeah. After that. So I can't say like if I had had thoughts of harm, would that have been enough to get me to see couple? I don't know. Yeah. Um because looking back, I'm like I can't I can't even believe that I didn't like knowing what I know now. Yeah. But I do think even with that hallucination, once I realized that she was just on the c on the bed sleeping, that I returned to my state of mind of thinking that I knew myself well enough that I would never harm her. Mhm. Yeah. That it was just a bad thought even though it was different from the other bad thoughts. And I think I I was asked [clears throat] If I knew I was psychotic, if I knew I had psychosis, I didn't have a word for it. And I'd heard the word, of course, before, but it was never something I ever would have applied to myself. Yeah. So, I knew something wasn't right. I knew I was having weird experiences, but I did not, in the way people ask, know I had psychosis. Sorry, you can say air quotes. [laughter] Yeah. [clears throat] So, then how did you recover? H slowly I mean I went from that state into a state of very deep depression for a long time that was also untreated. And um for me um I got pregnant again because even though I didn't want to have another child at that point um my husband wanted to have kids close in age and I just had I was like a little shell of myself. I had nothing in me to push back with. And you got to remember I I'd been an attorney. I'd been a litigator. Yeah. [laughter] I still didn't I didn't have that that strength in myself to to push back on that. So I got pregnant again and early on in that pregnancy I was actually doing pretty well except I kept feeling like there was something wrong and that was gnawing at me. And I kept asking if it could be twins and they kept I kept being told all the reasons why it couldn't be twins. And then we went for the ultrasound and found out it was twins, but we were told they were monoamniotic, but I also had um [clears throat] a physical thing that happened which ended up me having to be on bed rest. But I went to a doctor and for a higher level ultrasound found out they were not. But in the in the period of time between that diagnosis and seeing another doctor, I saw myself spiraling into a depression. like I could tell that I was, you know, spiraling in. When I was on bed rest, I found out through a chat that what I was describing to somebody in response to another question, a person was like, I'm a nurse and that's actually postpartum psychosis because I had figured I had depression, you know, once I noticed this during pregnancy. Um, and then I already mentioned I tried to learn about it. Um, and

the during the course of that pregnancy, I had anxiety on and off, depression on and off, but not as bad as the depression that I'd had prior to becoming pregnant. Post that birth, I actually did really well. But I had told my family at that point, if I do anything strange, if anything seems off, you need to get me to a doctor and you need to not leave me alone with kids. And actually, at this one point early on, they like I forget it was like maybe a week or two after they were born. Um, every I was staying at my parents house and um, my mother-in-law was there and and my parents are there. My brother and his now wife and my husband were all like in this big house together and they all decided to go out to this breakfast that was part of this organization we were part of. And [clears throat] I was like, I I got this. I can watch all three kids at home by myself. I'm good. And uh and I was and I knew I was, but given my history, they never should have left me alone with [laughter] the interesting. Um Yeah. I mean, and it wasn't even necessary that they did, but I knew I was okay. Yeah. But they can't know that from the outside. Sure. Sure. Right. So, especially somebody who's got a history of it, you want to be more careful than that. Um but then we moved and I ended up getting um dehydrated and I [clears throat] didn't know that dehydration can kick you into a depression. So, I noticed I was getting depressed and even after everything, even after everything I've described, I had made an appointment with the doctor and the night before my appointment, I was crying and I was saying to my husband, I'm like, I am so afraid of being diagnosed with depression, but I'm also afraid of not being diagnosed with depression because then what the hell's wrong with me? Sure. And now, of course, I look back and I'm like, "Oh my gosh, [laughter] I had so many things that were more severe than just some depression." Not not to minimize depression, but you know, um the fact that I was afraid of that diagnosis can give you an idea of how far I've come since then about myself and and what's possible. Well, and it also gives insight into how other people may also be feeling or how that lack of education can actually manifest in response, action, lack of seeking help, etc. Yep. And then in recovery, other than that, other than time, which is really not the best option for recovery is the that we need to do a lot more to support the post-reovery recovery for women who've had this. Knowing that depression can be very common afterwards, knowing that anxiety can be really common afterwards, knowing that there are a lot of times women with this have PTSD afterwards. um having therapists that are trained in this so they don't cause more harm by not being aware of what she is going through. And I and I actually run into that more than you might think. [laughter] Um and I've actually run into times when there are therap women who've told me about when therapists have made things worse. But absolutely I think some of the things that I hear about that help with recovery the most are having a really good therapist. That's big. Having good social support from people who are who are loving and gentle towards you and not judgmental and not blaming that help you get past anything that you've done that might have been harmful. Not bringing things up again that you weren't in control of, you know, uh but might have hurt their feelings. That's not the time for that. So having good social support, having a good therapist, and connecting with other survivors, that is one of the things I've heard from so many survivors because it can feel so alone and you can be told by professionals other women had this and you weren't to blame, but until you really understand that you're not alone, it can be really difficult. Totally. Totally. Yeah. And I like that the phrase from PSI, postpartum support international, is like you're not I use it in my class. You're not alone. You're not to blame. And with help it can get better or with help you'll be well. With help you'll be yourself again or Yeah. With help you yourself or Yeah. It it's changed over the years. I don't know what they're using right now. Yeah. Yeah. That's just what I've read and what I've like repeated because I think that's a hopeful message. Yep. Absolutely. And I think it goes to very fundamental needs that people have both at the moment for reassurance but also during recovery. Yeah. I just feel like this conversation is so relevant and so like helpful in this season of OB, you know, and as much as it is so devastating what happened with Lindsay and also all of those that are unnamed and named that it's like there's this whole it feels like to me there's this underground world of suffering that we're getting a window into. And so my hope and dream is that these episodes and I know I I just thank you so much for bringing your personal experience and being so vulnerable with this audience and I really know that this is the audience that then we can take what we've heard and taken in and it starts with that awareness of the suffering but also asking the question where do we fit because we do and our professional responsibility and our human responsibility is that you you know It's the Maya Angelou that's on our physiologic birth box that's like once you do the best you can until you know better, but once you know better, you do better. And so this community, I dream of us being those people who can go to our units and say, "What resources are we handing out? What is the messaging? Who are we giving it to? Are we circling it from the 40 pages that they get? Are we looking at the partners and saying, "Hey, FYI, this is what is needs to be an alert to you. Are we de-stigmatizing the conversations that are happening at our nurses stations when we're talking about Lindsay Clancy or others? You know, those patients in labor that maybe did have a hallucination or a delusion. I had someone in my DMs the other day that was like, I think I had someone psychotic that was in a psychosis in labor. And I'm like, yeah, that can happen, too. And so, you know, I I just am so grateful to you for being willing to come here and share your knowledge and expertise. if there's anywhere that you want to send them like so say I'm the nurse that's like give me more obviously those organizations that you just mentioned obviously your book and I know you mentioned that your book you write with a publisher that is uh more scholastically based if I can say it that way and so if the book is not accessible to you and you don't want to purchase there's also check your medical library and if your medical library doesn't have it you need to request that your medical library has this book that is an incredible resource for postpart postpartum psychosis, but also that your local library might have it, etc. As we all choose the things that tug at our heart springs strings, but also um continue to just be better and continue to level up our practice in that way. Any resources that have been mentioned in both of these episodes are in the description down below. So, make sure you check those out, including her book. We'll link the TED talk. We'll link whatever other resources she sends to me as we continue to just level up our practice. Thanks for spending your time with us during this episode of Happy Hour with Bundle Birth Nurses. If you like what you heard, it helps us if you subscribe, rate, leave a raving review, and share this episode with a friend. If you want more from us, head to the show notes down below cuz everything is linked down below. You can also go to bundlebirthnurses.com, subscribe to our email list, or follow us on Instagram. And so Teresa, I'm going to let you give the sendoff, but now it's your turn to take what you learned today, apply it to your life, and why labor and delivery nurses? Because in your life, other than labor and delivery, you might know people who get pregnant. And we can be those as a professional have a trained eye to notice that. We'll see you next time.